| NPI | 1386436871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 127766) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SL07305100) |
| Enumeration Date | 2025-05-20 |
| Last Update Date | 2025-07-03 |